| NPI | 1063880896 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ALVIN JOHN STOSICH Owner 801-566-5117 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: UT 64341369924) |
| Enumeration Date | 2015-09-10 |
| Last Update Date | 2015-09-10 |